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Procedure guide · Buttocks & Hip
Buttock ReductionButtock reduction makes the buttocks smaller, using liposuction where the bulk is fat and skin excision where the buttock is heavy and hanging. It is far less commonly requested than augmentation and is usually done for discomfort, difficulty with clothing or disproportion rather than appearance alone. Liposuction alone is the simpler route but makes loose skin more obvious, so skin quality determines which is possible.
Buttock reduction makes the buttocks smaller. It is requested far less often than augmentation, and the reasons patients give are usually practical rather than aesthetic: clothes that cannot be fitted without alteration, discomfort sitting or exercising, or a fold beneath the buttock that stays moist and develops recurrent rashes.
The operation takes one of two forms, and choosing correctly between them is where nearly all the satisfaction or disappointment originates. Where the bulk is fat sitting under skin that is still firm, liposuction alone reduces the buttock cleanly, leaving only access points a few millimetres long. Where the skin is already lax, removing the fat that filled it leaves a smaller buttock that hangs more than the larger one did.
Buttock skin retracts less reliably than skin over the abdomen, so the threshold for needing excision is lower here than patients expect. A surgeon who examines you and recommends removing skin is applying a real limit rather than upselling, and one who offers liposuction alone for a buttock that visibly hangs is choosing the operation that is easier to agree to.
Where excision is needed, the scar goes either in the crease beneath the buttock or horizontally across the upper buttock, depending on where the excess sits. Both can be covered by underwear. The problem is not visibility but healing: a closure on the buttock bears your weight whenever you sit, so partial separation is common and the sitting restriction afterwards exists to protect the wound.
How much smaller a buttock can be made is limited by more than preference. With liposuction, taking too much or working too close to the skin creates dents and waviness that are considerably harder to correct than to cause, and correcting them means grafting fat back in rather than removing more. With excision, the limit is how much skin can be removed without putting the closure under unmanageable tension.
It is worth asking the surgeon to describe the expected change in terms of how clothes will fit rather than in volume removed, because a figure in litres means very little on the buttock and invites a comparison with liposuction elsewhere that does not hold.
Buttock reduction is rarely done in isolation. Reducing the buttock while leaving the hips, thighs and lower back untreated can produce an outline that does not flow, so the region is usually treated as a unit. Where hanging skin extends around the whole lower trunk after major weight loss, a lower body lift is the operation that addresses it, and that is a considerably larger undertaking.
Recovery depends entirely on which version was done. Liposuction alone behaves like liposuction anywhere: firmness and lumpiness for weeks that patients frequently mistake for fat that was missed, compression for around 6 weeks, and a contour not worth judging before 3 months. Most people are back at a desk within a fortnight.
Where skin was excised, the recovery is longer and dominated by protecting the closure: limited sitting, a cushion that takes the weight through the thighs, sleeping face down or on the side, and the real possibility of a wound that opens in part and needs dressings. Establishing which version is planned before booking matters, because the two demand quite different trips.
Surgeons look for these points at the consultation.
Buttock reduction suits adults at a stable weight whose buttocks are disproportionately large or heavy for their frame, causing difficulty with clothing, discomfort when sitting or exercising, or skin problems in the fold beneath, who are in good health and do not smoke.
Reasons a good surgeon will ask you to wait or choose something else.
Buttock reduction is avoided in smokers who will not stop, in unstable weight or planned further weight loss, in poorly controlled diabetes, in previous blood clots, in active infection or skin problems over the buttocks, and where body image distress rather than physical excess is driving the request.
Ask your surgeon which technique they recommend for you and why.
Fat is removed from the buttocks through small access points, without excising skin. Suitable where the bulk is fat and the skin is firm enough to retract.
Skin and fat are removed together and the buttock is reshaped, with the scar placed in the crease beneath the buttock or across the upper buttock.
Volume is reduced and the remaining tissue is lifted, for buttocks that are both heavy and sagging, typically after major weight loss.
The buttock is reduced and lifted within a circumferential operation that also treats the abdomen, hips and outer thighs.
Step by step, from arrival to discharge.
Before buttock reduction the surgeon pinches the tissue to establish whether the bulk is fat under firm skin or fat under lax skin, which decides the operation.
The areas to be reduced are marked while you stand, because buttock tissue falls differently lying down and a plan made on the table treats the wrong areas.
Fat is removed evenly and not too superficially, since working close to the skin is what produces the dents that are hard to correct afterwards.
Where the skin is lax, a segment is removed with the fat and the scar is placed either in the infragluteal crease or across the upper buttock.
The two sides are compared with the patient repositioned where possible, because asymmetry is far easier to prevent than to revise later.
A garment goes on at the end of the operation to hold the skin against the underlying tissue while it reattaches, which reduces both swelling and irregularity.
Frequencies follow published guidance; your personal risk depends on your health and the surgeon.
The judgement that decides whether buttock reduction succeeds is made before any fat is removed, and it concerns skin. Where the bulk is fat sitting under firm skin, liposuction alone reduces the buttock cleanly with tiny scars. Where the skin is already lax, taking the fat away leaves that skin emptier, and the patient ends up with a smaller buttock that hangs more than the larger one did. Buttock skin retracts less reliably than skin over the abdomen, so the threshold for excision is lower here than patients expect.
Where skin is excised, the problem becomes the location. A closure on the buttock heals under load every time the patient sits, so partial separation is common rather than unlucky, and the sitting restriction that follows exists to protect the wound. Neither route is difficult surgery in itself; almost all the dissatisfaction after buttock reduction comes from choosing liposuction for a buttock that needed excision.
Altered sensation over the treated area is usual after buttock reduction and improves over 3 to 6 months, occasionally leaving numb patches.
Dents, waviness or asymmetry after buttock reduction, most often where liposuction has been used unevenly or too superficially.
Skin that was filled out by the fat does not always retract, so a buttock reduced by liposuction alone can end up smaller but looser.
Where skin is excised, the closure is sat upon and pulled by movement, so partial separation is common and can need dressings for weeks.
Fluid collecting in the space where tissue was removed, which may need draining with a needle at a clinic visit, sometimes repeatedly.
The two sides heal or settle differently, which minor revision under local anaesthesia can correct at around 6 months.
Surgery of this size, reduced mobility afterwards and a flight home together raise the risk above that of a day-case procedure.
Where buttock reduction is done by liposuction alone, the recovery is that of ordinary liposuction: firmness and lumpiness for weeks that patients frequently mistake for fat that was missed, compression worn for around 6 weeks, and a contour that is not worth judging before 3 months. Pain is moderate and most people are back at a desk within a fortnight.
Where skin has been excised, the recovery is longer and dominated by protecting the closure. Sitting is limited for the first weeks and done on a cushion that takes the weight through the thighs, sleeping is face down or on the side, and partial separation of the wound is common enough to plan for. That difference is worth establishing before booking, because the two versions of this operation demand very different trips.
Days 1-3
Usually a night in hospital. Compression garments worn continuously. Sitting limited, particularly where skin has been excised. Walking encouraged from the first evening.
Days 4-10
Bruising peaks around day 3 or 4 and then settles. Any incision is checked for separation. Flying is usually cleared at around day 10.
Weeks 2-4
Desk work at around 2 weeks, on a cushion where skin was excised. The treated area feels firm and lumpy, which is normal healing.
Weeks 6-8
Compression ends at around 6 weeks and swelling settles enough for the contour to be recognisable. Exercise resumes gradually.
Months 3-6
Firmness softens and the definitive shape appears. Buttock reduction should be judged at this point rather than at 6 weeks.
Buttock reduction produces a smaller, better proportioned buttock, and patients most often describe the change in terms of clothing rather than measurements.
Where a fold beneath the buttock was causing recurrent rashes, resolving that is frequently valued more than the change in appearance.
The contour takes 3 to 6 months to settle, since firmness and swelling obscure it for the first 6 to 8 weeks.
Where skin was excised, the scar continues fading for 12 months or more and may heal wider in the section that separated.
Buttock reduction is priced very differently depending on which operation is planned. Liposuction alone is a short procedure; excisional reduction is longer, needs a hospital bed and involves a closure that requires follow-up. Establish which is proposed before comparing anything.
Because it is requested far less often than augmentation, it is also worth confirming that the surgeon performs it regularly rather than occasionally. That experience is the part of the price worth paying for.
Where a documented history of recurrent infection or skin breakdown exists, particularly after major weight loss, some health systems consider funding excision. Investigating that with your own doctor first costs nothing but time.
Why quotes for the same procedure differ, so you can compare packages fairly.
Options to weigh before deciding, surgical and non-surgical.
Much the better option where the skin is firm enough to retract: tiny scars, a quicker recovery and no closure to protect.
Where the problem is that the buttock hangs rather than that it is too large, lifting rather than reducing is the operation.
Where hanging skin extends around the whole lower trunk after major weight loss, a circumferential operation treats it as one unit.
Sometimes the complaint is proportion rather than buttock size, and contouring the surrounding areas achieves more than reducing the buttock would.
Ask the same questions at every consultation so you can compare answers.
Liposuction alone works for buttock reduction where the bulk is fat and the skin is firm enough to retract afterwards. It is much the better option where it is possible, since it leaves only tiny access points and has a far easier recovery.
Where the skin is already loose, removing the fat that was filling it makes it hang more, and the result is a smaller buttock that looks worse. Buttock skin retracts less reliably than abdominal skin, so a surgeon who recommends excision after examining you is applying a real threshold rather than upselling.
The reasons are usually practical rather than aesthetic. Buttocks that are disproportionately large for the frame make clothes difficult to fit, cause discomfort when sitting or exercising, and can create a fold underneath that stays moist and develops recurrent rashes.
Disproportion matters to some patients as much as size: a figure that cannot be dressed without alteration, or that draws attention the patient does not want. Those are legitimate reasons, and a consultation should take them at face value rather than assuming everyone wants augmentation.
Liposuction leaves only access points a few millimetres long, tucked into a crease or where underwear covers them, and they are usually difficult to find once faded.
Where skin is excised, the scar sits either in the crease beneath the buttock or horizontally across the upper buttock, depending on where the excess is. Both can be covered by underwear, and the choice is made by examining where the skin actually hangs rather than by preference.
Less than most patients imagine from liposuction alone, because the safe limit is set by how much can be removed without creating dents and by how much the skin will retract afterwards. Taking too much is what produces the irregularity that is hard to correct.
Where skin is excised the change can be larger, since bulk and skin come away together. Either way, asking the surgeon to describe the expected change in terms of how clothes will fit is more useful than a volume figure, which means very little on the buttock.
After buttock reduction by liposuction alone, sitting is uncomfortable rather than prohibited and most patients manage normally within a few days, using a cushion for comfort in the first week or two.
Where skin has been excised, sitting is limited for the first 2 weeks and then done on a cushion supporting the thighs for several weeks, because the closure heals under load. That version also delays flying, usually to around day 10 or later.
Where the rash comes from a fold created by a heavy, hanging buttock, removing that overhang usually resolves it, and this is one of the more clearly functional reasons for the operation.
Where it is a skin condition unrelated to the fold, surgery will not help. Documenting the recurrent rashes with your own doctor first is worth doing both to clarify the goal and because some health systems consider funding excision on those grounds.
The fat cells removed do not return and the skin excised does not grow back, so the result holds as long as your weight stays reasonably stable. Buttock reduction is permanent in that sense.
What changes it is weight gain, which enlarges the fat cells that remain, and ageing, which gradually loosens the skin. Reaching a stable weight before the operation rather than after is what protects the result, and it is also what makes the surgical planning accurate.
Buttock reduction is very commonly combined with liposuction of the hips, thighs and lower back, since reducing the buttock alone can leave an outline that does not flow. Treating the region as a unit generally gives a better result than treating one part.
Where the problem extends to hanging skin around the whole lower trunk after major weight loss, a lower body lift treats it in one circumferential operation. That is a considerably larger undertaking and worth understanding as a different proposition rather than an extension.
Buttock reduction is moderately painful after liposuction alone, with most patients off strong painkillers within a week and describing firmness and tightness rather than pain. It is comparable to liposuction anywhere else on the body.
Where skin has been excised it is more uncomfortable, mostly because of the awkwardness: getting in and out of chairs, sleeping, and managing not to sit. Prescribed painkillers are usually needed for about a week and the practical restrictions last longer than the pain.
Minor waviness and asymmetry at 6 weeks very often settle by 6 months as swelling resolves and firmness softens, which is why no surgeon will discuss revision before then. Judging buttock reduction early leads to unnecessary worry.
Where a genuine dent remains, correction usually means grafting fat back into the depression rather than removing more, which is a more delicate operation than the original. That is the practical reason to choose a surgeon on evenness rather than on how much they will take.
Compression is worn after buttock reduction for around 6 weeks, and it matters more here than patients expect. The garment holds the skin against the underlying tissue while it reattaches, which reduces both fluid collection and the risk of an uneven contour.
Buy a second garment so one can be washed. Where skin has been excised as well, the garment also supports the closure, and the surgeon may specify a particular type rather than leaving it to you.
Ask what they find on examination: whether your bulk is fat under firm skin or fat under lax skin, because that single judgement determines which operation you need and it is where most dissatisfaction originates.
Then ask to see results at 6 months in patients with a similar build, photographed standing. Buttock reduction is far less commonly requested than augmentation, so it is worth confirming the surgeon actually performs it regularly rather than occasionally.
Buttock reduction and a buttock lift treat different problems. Buttock reduction makes a buttock that is too large smaller; a buttock lift raises one that hangs. A buttock can be both large and hanging, in which case the two are combined.
The distinction is made by examining you standing. Bulk with firm skin needs reduction; a fold of skin hanging over the crease beneath needs lifting. Getting it wrong is the commonest source of disappointment, and the names are no guide.
Once healed, buttock reduction generally makes sitting and exercising more comfortable rather than less, which for many patients is the reason they had it done. Removing bulk that was causing chafing or pressure resolves those problems.
In the first weeks the opposite applies, particularly where skin was excised, since the closure heals under load. Ask for a timetable for returning to your specific activities, because cycling and anything pressing on the buttocks takes longer than general exercise.
Buttock reduction very commonly is combined, and treating the region as a unit usually produces a better outline than reducing the buttock alone. Liposuction of the hips, outer thighs and lower back is the usual accompaniment.
Reducing the buttock in isolation can leave an outline that does not flow, with a smaller buttock above untreated thighs. A surgeon who proposes treating adjacent areas is thinking about proportion rather than adding to the bill, though it is fair to ask them to explain why.
Compression after buttock reduction runs around 6 weeks, worn essentially continuously at first and then during the day. The garment holds the skin against the underlying tissue while it reattaches, which reduces swelling, fluid collection and the risk of an uneven contour.
Buy a second garment so one can be washed. Where skin was excised as well, the garment also supports the closure, and the surgeon may specify a particular type rather than leaving the choice to you.
Buttock reduction can leave loose skin, and predicting that is the central judgement of the operation. Where skin is firm it retracts over the smaller buttock; where it is already lax, removing the fat that filled it leaves it hanging more than before.
Buttock skin retracts less reliably than abdominal skin, so the threshold for excising skin rather than relying on retraction is lower here. A surgeon recommending excision after examining you is applying that threshold rather than proposing a bigger operation for its own sake.
Not really. Fat cells removed do not return and excised skin does not grow back, so buttock reduction is a permanent change in the same way liposuction elsewhere is.
Where too much has been taken and the buttock looks flat or dented, the correction is fat grafting to put volume back rather than any reversal of the original operation. That is a more delicate procedure than the reduction was, which is the practical argument for conservative removal.
Where buttock reduction used liposuction alone, recovery is moderate: most patients are off prescribed painkillers within a week and describe tightness and firmness rather than pain. It is comparable to liposuction anywhere on the body.
Where skin was excised, more uncomfortable and more awkward, mostly because of the practical restrictions. Getting in and out of chairs, sleeping, and managing not to sit dominate the first fortnight, and patients consistently describe those as harder than the pain itself.
Dents after buttock reduction come from removing fat unevenly or from working too close to the skin, which tethers it to the underlying tissue. They are considerably easier to cause than to correct, which is why a careful surgeon takes less rather than more.
Minor waviness at 6 weeks usually settles by 6 months as swelling resolves and firmness softens, so no surgeon will discuss revision before then. A genuine dent that remains is corrected by grafting fat into it and releasing the tethering beneath.
The useful test is whether the problem is physical or proportional. Recurrent rashes in a fold, difficulty fitting clothing, or discomfort sitting and exercising are concrete problems that buttock reduction addresses reliably.
Where the concern is how the buttock looks relative to an ideal rather than what it stops you doing, it is worth more thought, because a smaller buttock does not always resolve the feeling that prompted the enquiry. A surgeon who raises that rather than taking the booking is doing the job properly.
Flying home after buttock reduction takes around 10 days, and longer where skin was excised, since the closure needs checking before you travel and sitting for several hours presses directly on it.
Take a cushion, wear the compression garment for the flight, stand up regularly and follow the clot prevention advice. One-sided calf pain or breathlessness after you get home should be treated as an emergency rather than attributed to the surgery.
Buttock reduction is performed on men, usually for disproportion or for fullness that has persisted after weight loss, and the operation is the same. Men more often have firm skin that retracts, so liposuction alone is more frequently sufficient.
Where gynaecomastia or wider body contouring is also being considered, treating the areas together is worth discussing, since reducing one region in isolation can leave an outline that does not flow.
An examination standing, because the assessment that matters is whether your bulk sits under firm skin or under lax skin, and that cannot be judged from photographs or from a description.
Expect the surgeon to pinch the tissue, to look at the fold beneath the buttock, and to discuss the surrounding areas rather than the buttock alone. A consultation that quotes a price without examining you has skipped the step that determines which operation you actually need.
Some clinics offer simulations, and they are worth treating with caution. Buttock reduction changes shape in ways that depend on how the skin retracts, which no simulation can predict, so an image can promise a result the tissue will not deliver.
Photographs of the surgeon’s own patients at 6 months, standing, in people with a similar build, are far more informative. Ask specifically for patients whose starting point resembled yours rather than the best results in the gallery.
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